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Cardiovascular System Block Cardiac Arrhythmias (Physiology ). Dr. Mona Soliman , MBBS, MSc , PhD Associate Professor Department of Physiology Chair of Cardiovascular Block College of Medicine King Saud University. Lecture Objectives. Describe sinus arrhythmias - PowerPoint PPT Presentation
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Cardiovascular System BlockCardiac Arrhythmias
(Physiology)Dr. Mona Soliman, MBBS, MSc, PhD
Associate ProfessorDepartment of Physiology
Chair of Cardiovascular BlockCollege of Medicine
King Saud University
Lecture Objectives
Describe sinus arrhythmiasDescribe the main pathophysiological causes
of cardiac arrhythmiasExplain the mechanism of cardiac blockExplain the origin of an ectopic fociEnumerate the common arrhythmias and
describe the basic ECG changes
Normal Sinus Rhythm
RegularSingle p-wave precedes every QRS complexP-R interval is constant and within normal
rangeP-P interval is constant
Causes of Cardiac Arrhythmias
1. Abnormal rhythmicity of the pacemaker2. Shift of the pacemaker from the sinus node to
another place in the heart3. Blocks at different points during the spread of the
impulse through the heart4. Abnormal pathways of impulse transmission
through the heart5. Spontaneous generation of spurious impulses in
almost any part of the heart
Causes of Cardiac Arrhythmias
Rate above or below normal Regular or irregular rhythm Narrow or broad QRS complex Relation to P waves
Abnormal Sinus Rhythm
Tachycardia: an increase in the heart rateHeart rate > 100 beats per minuteCauses:
Increased body temperatureSympathetic stimulationDrugs: digitalisInspiration
Abnormal Sinus RhythmBradycardia:
Slow heart rate < 60 beats per minuteCauses:
Parasympathetic stimulationExpiration
Abnormal Cardiac Rhythms that Result from Impulse Conduction BlockSinoatrial Block
Blockasde of the S-A node impulse before entering atrial muscle
Cessation of P waveCauses:
Ischemia of the A-V nodeCompression of the A-V node by scar formationInflammation of the A-V nodeStrong vagal stimulation
Abnormal Cardiac Rhythms that Result from Impulse Conduction Block
A-V BlockWhen impulse from the S-A node is blockedCauses:
Ischemia of the A-V nodeCompression of the A-V node by scar
formationInflammation of the A-V nodeStrong vagal stimulation
Types of the A-V Block
First degree blockSecond degree blockThird degree block
First degree blockProlong P-R interval (0.2 seconds)
Types of the A-V Block
Types of the A-V block
Second Degree Block • P-R interval > 0.25 second• Only few impulses pass to the ventricles
atria beat faster than ventricles“dropped beat” of the ventricles
Third degree block (complete)• Complete dissociation of P wave and QRS wavesVentricle escape from the influence of S-A nodeAtrial rate is 100 beats/minVentricular rate is 40 beats/min• Stokes-Adams Syndrome: AV block comes and
goes
Types of the A-V block
Premature contractions
Premature contractions, extrasystoles, or ectopic beat result from ectopic foci that generate abnormal cardiac impulses (pulse deficit)
Causes:IschemiaIrritation of cardiac muscle by calcified fociDrugs like caffeine
Ectopic foci can cause premature contractions that originate in:The atriaA-V junctionThe ventricles
Premature Atrial Contractions
Short P-R interval depending on how far the ectopic foci from the AV node
Pulse deficit if there is no time for the ventricles to fill with blood
The time between the premature contraction and the succeeding beat is increased (Compensatory pause)
Prolong QRS complex because the impulses are carried out with myocardial fibers with slower conduction rate than Purkinje fibers
Increase QRS complexes voltage because QRS wave from one ventricle can not neutralize the one from the other ventricle
After PVCs, the T wave has an electrical potential of opposite polarity of that of the QRS because of the slow conduction in the myocardial fibers, the fibers that depolarizes first will repolarize first
Causes: drugs, caffeine, smoking, lack of sleep, emotional irritations
Premature Ventricular Contractions (PVCs)
Ventricular Fibrillation
• The most serious of all arhythmias
• Cause: impulses stimulate one part of the ventricles, then another, then itself. Many part contracts at the same time while other parts relax (Circus movement)
Ventricular Fibrillation• Causes: sudden electrical shock, ischemia
TachycardiaIrregular rhythmBroad QRS complexNo P wave
Treatment : DC shock
Ventricular Fibrillation
Atrial FibrillationSame mechanism as ventricular fibrillation. It can occur
only in atria without affecting the ventriclesIt occurs more frequently in patients with enlarged heartThe atria do not pump if they are fibrillatingThe efficiency of ventricular filling is decreased 20 to
30%No P wave, or high frequency of low voltage P waveTreatment: DC shock
A single large wave travels around and around in the atriaThe atria contracts at high rate (250 beats/min)Because one area of the atria is contracted and another one
is relaxed, the amount of blood pumped by the atria is slightThe refractory period of the AV node causes 2-3 beats of
atria for one single ventricular beat 2:1 or 2:3 rhythm
Atrial Flutter
Ischemia and the ECGOne of the common uses of the ECG is in
acute assessment of chest painCause: restriction of blood flow to the
myocardium, either:Reversible: angina pectorisIrreversible: myocardial infarction
Ischemia injury infarction
Reversible ischemia
Inverted T waveST segment depression
Myocardial Infarction
Complete loss of blood supply to the myocardium resulting in necrosis or death of tissue
ST segment elevation Deep Q wave
Potassium and the ECG
Hypokalemia: flat T wave
Hyperkalemia:Tall peaked T wave
For further readings and diagrams:
Textbook of Medical Physiology by Guyton & HallChapter 10 (Cardiac Arrhythmias and their
Electrocardiographic Interpretation)